中华眼视光学与视觉科学杂志
中華眼視光學與視覺科學雜誌
중화안시광학여시각과학잡지
CHINESE JOURNAL OF OPTOMETRY OPHTHALMOLOGY AND VISUAL SCIENCE
2011年
2期
140-143
,共4页
赵海岚%戚晓虹%沈维%叶明霞%吴苗琴
趙海嵐%慼曉虹%瀋維%葉明霞%吳苗琴
조해람%척효홍%침유%협명하%오묘금
肾透析%前房%晶状体,眼%眼内压
腎透析%前房%晶狀體,眼%眼內壓
신투석%전방%정상체,안%안내압
Renal dialysis%Anterior chamber%Lens,eyes%Intraocular pressure
目的 探讨慢性肾衰患者血液透析(简称血透)前后前房角宽度(鼻侧、颞侧、上方、下方)、中央前房深度、晶状体厚度和眼压的变化,以及这些改变与患者血透过程中各项血液指标改变的关系.方法 回顾性系列病例研究.选取因慢性肾衰长期在浙江省人民医院进行血透治疗的35名患者(70眼),分别在血透前及血透后测量眼压、眼部A超(品状体厚度)以及应用索维全景超声生物显微镜进行眼前段结构扫描(中央前房深度、小梁虹膜角、房角开放距离).根据血透前的前房角镜检查分为窄角组及宽角组,并测量其血透前后的眼压.测量血透前后上述患者尿素氮、肌酐、血浆渗透压、白蛋白及脱水量.采用配对t检验对各项结果进行分析.结果 35名(70跟)慢性肾衰患者血透后的眼压较血透前升高(t=-3.389,P＜0.05).血透后中央前房深度较血透前显著变浅(t=8.043,P＜0.01).血透后眼鼻侧、颞侧、上方、下方的小梁虹膜角及房角开放距离均较血透前变小(小梁虹膜角:t＝4.637、8.893、3.575、3.436,房角开放距离:t=3.122、5.372、3.838、2.915,P均＜0.01),晶状体厚度变厚(t＝-9.132,P＜0.01).窄角组(14眼)血透后眼压显著增高(t＝-0.045,P＜0.01),而宽角组(56眼)血透后跟压较血透前差异无统计学意义(t＝-9.515,P＞0.05).血透后的血尿素氮、肌酐、血浆渗透压较血透前显著降低(t=16.075、13.676、113.063,P均＜0.01),白蛋白较血透前增高(t＝-7.756,P＜0.01).结论 由于血透治疗后液体顺渗透压梯度移动至眼内,慢性肾衰患者血透后前房深度较血透前变浅,前房角变窄,晶状体变厚,具有窄房角的患者血透后眼压显著增高.故建议对慢性肾衰患者在血透治疗前进行前房状态评估,并进行相应的处理.
目的 探討慢性腎衰患者血液透析(簡稱血透)前後前房角寬度(鼻側、顳側、上方、下方)、中央前房深度、晶狀體厚度和眼壓的變化,以及這些改變與患者血透過程中各項血液指標改變的關繫.方法 迴顧性繫列病例研究.選取因慢性腎衰長期在浙江省人民醫院進行血透治療的35名患者(70眼),分彆在血透前及血透後測量眼壓、眼部A超(品狀體厚度)以及應用索維全景超聲生物顯微鏡進行眼前段結構掃描(中央前房深度、小樑虹膜角、房角開放距離).根據血透前的前房角鏡檢查分為窄角組及寬角組,併測量其血透前後的眼壓.測量血透前後上述患者尿素氮、肌酐、血漿滲透壓、白蛋白及脫水量.採用配對t檢驗對各項結果進行分析.結果 35名(70跟)慢性腎衰患者血透後的眼壓較血透前升高(t=-3.389,P＜0.05).血透後中央前房深度較血透前顯著變淺(t=8.043,P＜0.01).血透後眼鼻側、顳側、上方、下方的小樑虹膜角及房角開放距離均較血透前變小(小樑虹膜角:t＝4.637、8.893、3.575、3.436,房角開放距離:t=3.122、5.372、3.838、2.915,P均＜0.01),晶狀體厚度變厚(t＝-9.132,P＜0.01).窄角組(14眼)血透後眼壓顯著增高(t＝-0.045,P＜0.01),而寬角組(56眼)血透後跟壓較血透前差異無統計學意義(t＝-9.515,P＞0.05).血透後的血尿素氮、肌酐、血漿滲透壓較血透前顯著降低(t=16.075、13.676、113.063,P均＜0.01),白蛋白較血透前增高(t＝-7.756,P＜0.01).結論 由于血透治療後液體順滲透壓梯度移動至眼內,慢性腎衰患者血透後前房深度較血透前變淺,前房角變窄,晶狀體變厚,具有窄房角的患者血透後眼壓顯著增高.故建議對慢性腎衰患者在血透治療前進行前房狀態評估,併進行相應的處理.
목적 탐토만성신쇠환자혈액투석(간칭혈투)전후전방각관도(비측、섭측、상방、하방)、중앙전방심도、정상체후도화안압적변화,이급저사개변여환자혈투과정중각항혈액지표개변적관계.방법 회고성계렬병례연구.선취인만성신쇠장기재절강성인민의원진행혈투치료적35명환자(70안),분별재혈투전급혈투후측량안압、안부A초(품상체후도)이급응용색유전경초성생물현미경진행안전단결구소묘(중앙전방심도、소량홍막각、방각개방거리).근거혈투전적전방각경검사분위착각조급관각조,병측량기혈투전후적안압.측량혈투전후상술환자뇨소담、기항、혈장삼투압、백단백급탈수량.채용배대t검험대각항결과진행분석.결과 35명(70근)만성신쇠환자혈투후적안압교혈투전승고(t=-3.389,P＜0.05).혈투후중앙전방심도교혈투전현저변천(t=8.043,P＜0.01).혈투후안비측、섭측、상방、하방적소량홍막각급방각개방거리균교혈투전변소(소량홍막각:t＝4.637、8.893、3.575、3.436,방각개방거리:t=3.122、5.372、3.838、2.915,P균＜0.01),정상체후도변후(t＝-9.132,P＜0.01).착각조(14안)혈투후안압현저증고(t＝-0.045,P＜0.01),이관각조(56안)혈투후근압교혈투전차이무통계학의의(t＝-9.515,P＞0.05).혈투후적혈뇨소담、기항、혈장삼투압교혈투전현저강저(t=16.075、13.676、113.063,P균＜0.01),백단백교혈투전증고(t＝-7.756,P＜0.01).결론 유우혈투치료후액체순삼투압제도이동지안내,만성신쇠환자혈투후전방심도교혈투전변천,전방각변착,정상체변후,구유착방각적환자혈투후안압현저증고.고건의대만성신쇠환자재혈투치료전진행전방상태평고,병진행상응적처리.
Objective To investigate changes in the width of the iridocorneal angle in the four quadrants (nasal, temporal, superior, inferior), central anterior chamber depth, lens thickness and intraocular pressure (IOP) in patients with chronic renal failure after hemodialysis. Methods Retrospective case series study. Thirty-five patients (70 eyes) with chronic renal failure were measured with tonometry (IOP), A/B scan (lens thickness) and ultrasound biomicroscopy (central anterior chamber depth, the trabecular iris angle and four directions of the angle opening distance) before and after hemodialysis. The patients were divided into 2 groups based on gonioscopy results: a narrow angle group (14 eyes) and an open angle group (56 eyes). IOP was measured in the 2 groups before and after hemodialysis. The patients' blood urea nitrogen (bun), creatinine (scr), albumin (alb),plasma osmotic pressure and dehydration were also checked before and after hemodialysis. All changes in the parameters were analyzed with a paired t test. Results IOP increased significantly in 35 patients (70 eyes) after hemodialysis (t=-3.389, P＜0.05). Central anterior chamber depth (t=8.043,P＜0.01), iridocorneal angle width (t=4.637, 8.893, 3.575, 3.436, P＜0.01 for all), and angle opening distance (t=3.122, 5.372, 3.838, 2.915, P＜0.01 for all) in 35 patients decreased, with the lens becoming significantly thicker (t=-9.132, P＜0.01) after hemodialysis. The IOP in narrow angle eyes (14 eyes) increased significantly (t=-0.045, P＜0.01) after hemodialysis while the IOP in open angle eyes (56 eyes) showed no significant change (t=-9.515, P＞0.05). Bun, scr and plasma osmotic pressure decreased in 35 patients (t=16.075, 13.676, 113.063, P＜0.01 for all) and alb increased (t=-7.756, P＜0.01) after hemodialysis. Conclusion Due to the movement of liquid in eyes cause by the osmotic pressure gradient after hemodialysis, the eyes of patients with chronic renal failure are characterized by a shallower central anterior chamber depth, a narrower iridocorneal angle width and a thicker lens. In addition, the IOP of narrow angle eyes increase significantly. As a result, it is recommended that the anterior chamber structure of patients with chronic renal failure should be checked and patients should receive appropriate treatment before hemodialysis.
